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1.
Lowry  SFCalvano  SEHoward  RJedSimmons  RJed Soluble cytokine and hormonal mediators of immunity and inflammation.  Surgical Infectious Diseases. 3rd ed. Norwalk, Conn Appleton & Lange1995;313- 326Google Scholar
2.
Cerra  FBHoward  RJedSimmons  RJed Infection, the inflammatory response, and multiple organ dysfunction.  Surgical Infectious Diseases. 3rd ed. Norwalk, Conn Appleton & Lange1995;387- 400Google Scholar
3.
Beutler  BARoth  BLedNielsen  TBedMcKee  AEed Orchestration of septic shock by cytokines: the role of cachectin (tumor necrosis factor).  Molecular and Cellular Mechanisms of Septic Shock. New York, NY Alan R Liss Inc1989;219- 235Google Scholar
4.
Bone  RC The pathogenesis of sepsis.  Ann Intern Med. 1991;115457- 469Google ScholarCrossref
5.
Rackow  ECAstiz  ME The pathophysiology and treatment of septic shock.  JAMA. 1991;266548- 554Google ScholarCrossref
6.
Wenzel  RP Anti-endotoxin monclonal antibodies.  N Engl J Med. 1992;3261151- 1152Google ScholarCrossref
7.
Ziegler  EJFisher  CJSprung  CI  et al.  Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin.  N Engl J Med. 1991;324429- 436Google ScholarCrossref
8.
Greenman  RLSchein  RMNMartin  MA  et al.  A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis.  JAMA. 1991;2661097- 1102Google ScholarCrossref
9.
Opal  SMFisher Jr  CJDhainaut  J-F  et al.  Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial.  Crit Care Med. 1997;251115- 1124Google ScholarCrossref
10.
Zeni  FFreeman  BNatanson  C Anti-inflammatory therapies to treat sepsis and septic shock: a reassessment.  Crit Care Med. 1997;251095- 1100Google ScholarCrossref
11.
Van Zee  KJKohno  TFischer  ERock  CSMoldawer  LLLowry  SF Tumor necrosis factor soluble receptors circulate during experimental and clinical inflammation and can protect against excessive TNF-α in vitro and in vivo.  Proc Natl Acad Sci U S A. 1992;894845- 4849Google ScholarCrossref
12.
Marano  MAFong  YMoldawer  LL  et al.  Serum cachectin/TNF in critically ill burn patients correlates with infection and mortality.  Surg Gynecol Obstet. 1990;17032- 38Google Scholar
13.
Fisher Jr  CJAgosti  JMOpal  SM  et al.  Treatment of septic shock with the tumor necrosis factor receptor:Fc fusion protein.  N Engl J Med. 1996;3341697- 1702Google ScholarCrossref
14.
Marshall  JCCook  DJChristou  NVBernard  GRSprung  CLSibbald  WJ Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.  Crit Care Med. 1995;231638- 1652Google ScholarCrossref
15.
Knaus  WAWagner  DPDraper  EA  et al.  The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults.  Chest. 1991;1001619- 1636Google ScholarCrossref
16.
Hebert  PCDrummon  AJSinger  JBernard  GRRussell  JA A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome.  Chest. 1993;104230- 235Google ScholarCrossref
17.
Knaus  WAHarrell  FEFisher  CJ  et al.  The clinical evaluation of new drugs for sepsis: a prospective study design based on survival analysis.  JAMA. 1993;2701233- 1241Google ScholarCrossref
18.
Barriere  SLLowry  SF An overview of mortality risk prediction in sepsis.  Crit Care Med. 1995;23376- 393Google ScholarCrossref
19.
Meek  MMunster  AMWinchurch  RADickerson  C The Baltimore Sepsis Scale: measurement of sepsis in patients with burns using a new scoring system.  J Burn Care Rehabil. 1991;12564- 568Google ScholarCrossref
20.
Casey  LCBalk  RABone  RC Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome.  Ann Intern Med. 1993;119771- 778Google ScholarCrossref
21.
Barie  PSHydo  LJ Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization.  Arch Surg. 1996;1311318- 1323Google ScholarCrossref
22.
Knaus  WAHarrell Jr  FELa Brecque  JF  et al.  Use of predicted risk of mortality to evaluate the efficacy of anticytokine therapy in sepsis: the rhIL-1ra Phase III Sepsis Syndrome Study Group.  Crit Care Med. 1996;2446- 56Google ScholarCrossref
23.
Calvano  SEvan der Poll  TCoyle  SMBarie  PSMoldawer  LLLowry  SF Monocyte tumor necrosis factor receptor levels as a predictor of risk in human sepsis.  Arch Surg. 1996;131434- 437Google ScholarCrossref
24.
Calvano  SEThompson  WACoyle  SM  et al.  Changes in monocyte and soluble TNF receptors during endotoxemia or sepsis.  Surg Forum. 1993;44114- 116Google Scholar
25.
Van Zee  KJCoyle  SMCalvano  SE  et al.  Influence of IL-1 receptor blockade on the human response to endotoxemia.  J Immunol. 1995;1541499- 1507Google Scholar
26.
Calvano  SEAlbert  JDLegaspi  A  et al.  Comparison of numerical and phenotypic leukocyte changes during constant hydrocortisone infusion in normal subjects with those in thermally-injured patients at 24-48 hours following burn.  Surg Gynecol Obstet. 1987;164509- 520Google Scholar
27.
van der Poll  TCalvano  SEKumar  A  et al.  Endotoxin induces downregulation of tumor necrosis factor receptors on circulating monocytes and granulocytes in humans.  Blood. 1995;862754- 2759Google Scholar
28.
van der Poll  TCalvano  SEKumar  ACoyle  SMLowry  SF Epinephrine attenuates down-regulation of monocyte tumor necrosis factor receptors during human endotoxemia.  J Leukoc Biol. 1997;61156- 160Google Scholar
29.
Not Available, Linear regression  Electronic Statistics Textbook. Tulsa, Okla StatSoft Inc1997;Web site. Available at:http://www.statsoft.com/textbook/stathome.htmlAccessed March 28, 1998Google Scholar
Paper
December 1998

Multivariate Analysis of 9 Disease-Associated Variables for Outcome Prediction in Patients With Sepsis

Author Affiliations

From the Division of Surgical Sciences, Department of Surgery, University of Medicine and Dentistry of New Jersey[[ndash]]Robert Wood Johnson Medical School, New Brunswick (Drs Calvano and Lowry and Ms Coyle), and Department of Surgery, Cornell University Medical College, New York, NY (Ms Barbosa and Dr Barie).

Arch Surg. 1998;133(12):1347-1350. doi:10.1001/archsurg.133.12.1347
Abstract

Objective  To assess the ability of 9 clinical or biological variables to predict outcome (survival or nonsurvival) using multiple regression and classification analyses.

Design  Prospective, descriptive cohort study with no interventions.

Setting  Surgical intensive care unit of a tertiary care hospital and a medical school research laboratory.

Patients  Eighteen patients with a documented source of infection who met currently accepted criteria for sepsis syndrome or septic shock.

Main Outcome Measures  Prediction of survival or nonsurvival based on analysis of clinical (Multiple Organ Dysfunction score, Acute Physiology and Chronic Health Evaluation III scores) and biological (plasma levels of cortisol, interleukin 6, interleukin 10, phospholipase A2, soluble tumor necrosis factor receptor p75, and monocyte membrane tumor necrosis factor receptor levels) variables, with comparison of predicted and actual outcomes.

Results  Plasma interleukin 6, interleukin 10, and phospholipase A2 concentrations were not significantly (P>.05) different between survivors and nonsurvivors. By standard, forward stepwise, and backward stepwise multiple regression analyses, only monocyte membrane tumor necrosis factor receptor levels measured at the onset of sepsis significantly predicted outcome in all 3 analyses. However, by both standard and backward stepwise analyses, Multiple Organ Dysfunction scores based on evaluation at the onset of sepsis and 24 hours later were also significant predictors of outcome. Classification analysis showed that assignment to outcome group was statistically significant when based on monocyte membrane tumor necrosis factor receptor levels determined at the onset of sepsis or on Multiple Organ Dysfunction scores assessed 24 hours after sepsis was diagnosed.

Conclusion  Although these findings were based on a relatively small cohort, both multiple regression and classification analyses indicated that only monocyte membrane tumor necrosis factor receptor levels are able to discriminate survivors from nonsurvivors at the onset of sepsis.

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